Silver D F, Ashwell T R
Division of Gynecologic Oncology, Yale University Medical School, New Haven, Connecticut 06520-8063, USA.
Gynecol Oncol. 2001 Sep;82(3):510-5. doi: 10.1006/gyno.2001.6319.
The purpose of this report was to describe a rationale for choosing from a variety of techniques to construct continent urinary diversions for patients who undergo pelvic exenterations. Moreover, this report evaluated the technique and utility of a continent urostomy created from a supracecal segment of colon.
The charts from patients who underwent pelvic exenterations and urinary diversions by DFS between September 1999 and December 2000 were reviewed after institutional review board approval. Data were recorded and evaluated.
Four patients underwent total pelvic exenterations and one received an anterior exenteration. Recurrent vulvar, vaginal, and cervical cancers were diagnosed in one, one, and two of the patients. One patient had an unknown primary squamous cell carcinoma in the pelvis. Four of the five received prior pelvic radiotherapy either in the neoadjuvant setting or as treatment for their primary disease. All five patients chose to have continent urostomies constructed. One Kock (ileal) pouch, one Miami (iliocolonic) pouch, and three supracecal colonic continent urostomies (SCCCU) were built. All five maintained continence over the follow-up period (mean follow-up time = 8.2 months). No complications related to the urostomies required reoperation. A new technique to for the construction of a SCCCU is described.
With a variety of procedures established to build continent urostomies, the choice of which to use should be individualized to the patient's situation as well as to the surgeon's experience. The use of a SCCCU requires moderately complex manipulations of the colon (described in the text) and a slight increase in the operative time; however, it results in successful continence and avoids complications related to radiation-injured bowel. It may be considered the procedure of choice for patients who have received prior radiation therapy. Long-term follow-up is needed.
本报告旨在阐述为接受盆腔脏器清除术的患者从多种技术中选择可控性尿流改道术的理论依据。此外，本报告评估了利用结肠盲肠上段构建可控性尿流改道术的技术及效用。
经机构审查委员会批准后，回顾了1999年9月至2000年12月期间接受盆腔脏器清除术并行尿流改道术的患者病历。记录并评估数据。
4例患者接受了全盆腔脏器清除术，1例接受了前盆腔脏器清除术。1例、1例和2例患者分别被诊断为复发性外阴癌、阴道癌和宫颈癌。1例患者盆腔内有原发性不明的鳞状细胞癌。5例患者中有4例在新辅助治疗阶段或作为原发性疾病的治疗接受过盆腔放疗。所有5例患者均选择构建可控性尿流改道术。构建了1个Kock（回肠）袋、1个迈阿密（回结肠）袋和3个盲肠上段结肠可控性尿流改道术（SCCCU）。所有5例患者在随访期间均保持控尿（平均随访时间=8.2个月）。未发生与尿流改道术相关的需要再次手术的并发症。描述了一种构建SCCCU的新技术。
鉴于已确立多种构建可控性尿流改道术的方法，应根据患者情况及外科医生的经验对选用何种方法进行个体化选择。使用SCCCU需要对结肠进行适度复杂的操作（文中有描述），手术时间略有增加；然而，它能成功实现控尿并避免与放射性损伤肠管相关的并发症。对于既往接受过放疗的患者，它可被视为首选术式。需要进行长期随访。
